Case Study: Shaping Study in a Child with Spectrum Disorder and Stuttering

Şükriye KAYHAN AKTÜRK1 , Nevin YILMAZ-ÇİFTECİ2 and Mehmet Ali AKAY3

1Department of and Therapy, Anadolu University, Eskişehir, Turkey ([email protected]) 2Department of Speech and Language Therapy, Cappadocia University, Nevşehir, Turkey ([email protected]) 3Atatürk State Hospital, Düzce, Turkey ([email protected])

INTRODUCTION RESULTS

Stuttering and Disorder (ASD) are common disorders that speech language therapists (SLP) may confront in their clinical settings frequently. When these two disorders comorbid it becomes rarer and a more complicated condition.

The relationship between stuttering and comorbid disorders such as autism spectrum disorder (ASD) has just started to be discussed in the literature. There is an increase in the number of case reports of children with ASD who stutter (Miyamato and Tsuge, 2021). When stuttering and ASD co-occur the communication of the child becomes more disrupted (Brundage, Whelan and Burgess, 2012).

There is limited research that describe the effectiveness of therapy techniques for children with ASD and stuttering. The aim of the recent study is to investigate effectiveness of the fluency shaping therapy program to reduce stuttering frequency in a child with ASD.

CASE DESCRIPTION Figure 1. Number of total syllables and stuttered syllables The participant is a 10-year-old male who has been diagnosed as ASD at age 3 years. Besides, he also started stuttering at the age of 3. The participants has the highest number of stuttered syllables in the first session. Total number of syllables change in each session � = 340, 76 . Number of stuttered syllables also changes Per parent report, there is no apparent reason why stuttering was started. Five months accordingly � = 38, 07 . before the initiation of the current study the participant received a stuttering evaluation at University Research Centre for Speech and Language Disorders. Results of this evaluation showed that the case has severe stuttering characterized by word and phrase repetitions and prolongations, a high rate of disfluency (27,6 % of spoken syllables) without secondary behaviors such as eye closing, head shaking etc. Furthermore, he was aware of stuttering behaviors.

Although he had difficulties in pragmatic skills, other language modalities such as semantic, morphology, phonology and syntax were better. He could maintain long conversations especially when the topic is in his interest areas. On the other hand, sometimes he might speak out of context.

METHOD

Intervention Fluency shaping methods was implemented in the therapy sessions. Fluency shaping is a method of acquiring new fluent speech as an appropriate behavior in the speech of people who stutter. The goal of fluency shaping is to teach a new way of speaking that is Figure 2. Stuttering frequency rate incompatible with stuttering, focusing primarily on the behavioral aspects of stuttering. Examples of therapy techniques include “gentle onset,” “light contact,” “rate reduced,” and The participants’ stuttering frequency rate does not follow steady line. From the first session to “prolonged (Guitar, 2006). The participant attended one session per week totally in the last session stuttering frequency rate increases and decreases without a specific pattern. The 12 clinical sessions. Fluency shaping methods was studied in a hierarchy (word level, participants’ rate was 27,6% in the evaluation session. Until intervention starts it reduced sentence level, conversation etc.) Once the participant had achieved the conversational spontaneously. During the whole therapy process it never shows plateau. level with his clinician through generalization games, unfamiliar listeners were invited into the treatment sessions in order to generalize his fluency skills to unfamiliar listeners.

Procedure Figure 3. Level of of mother The participant’s percentage of stuttered syllables (stuttering frequency) was calculated For three times level mother of the during conversational interactions with multiple conversation partners within and outside of participant was asked to rate her anxiety the clinic weekly. Stuttering frequency in speech was calculated by obtaining the number of level out of 10. Her level of anxiety stuttered syllables in a natural speech sample consisting of minimum 400 syllables, then gradually decreased until the end of the dividing the number of stuttered syllables by the total number of syllables, and then therapy sessions. converting the result into a percentage.

The following formula is used in the calculation of stuttering frequency (SF)

�ℎ� ������ �� ��������� ��������� DISCUSSION �� = � 100 ����� ������ �� ��������� In the study by Miyamato and Tsuge (2021) the participants were two children with stuttering and ASD. The factors influencing the prognoses of two children with stuttering and ASD were investigated. While Besides the mother’s anxiety level about his child’s stuttering was calculated before, at the one child’s stuttering had improved and had almost been eliminated, the other’s stuttering continued. middle and at end of the therapy process. The mother was asked to mark her anxiety level The child who continued to stutter showed high level of anxiety than the other. by giving a score out of 10 perceptionally. Brundage, Whelan and Burgess (2012) were conducted a study with an adult with ASD in order to Data Analysis examine the effectiveness of a modified version of the fluency rules program to reduce stuttering frequency. This program was based on fluency shaping methods. It was found that the percentage of The findings related to stuttering frequency and parent’s anxiety level were presented as stuttered words (%SW) was reduced by the application of the program. A reduction was revealed in frequency and percentage. SPSS 24.0 package program was used for statistical analysis. %SW from an average of 14.5 %SW during baseline to 2.07 %SW during the withdrawal phase.

REFERENCES Brundage, S. B., Whelan, C. J., & Burgess, C. M. (2013). Brief Report: Treating stuttering in an adult with autism spectrum disorder. Journal of autism and developmental disorders 43 (2), 483-489. Miyamato, S., & Tsuge, M. (2021). Treating Stuttering in Children with Autism Spectrum Disorder. In Education and Technology Support for Children and Young Adults with ASD and Learning Disabilities (pp. 208-222). IGI Global. Guitar, B. (2006). Stuttering: An intagrated approach to its nature and treatment. Baltimore: Lippincott Williams and Wilkins.